EBF 4 month old... Doctor said to start iron supplement?

[Amalee]

Today my son had his 4 month check up. The doctor asked about what he is eating and when I wanted to start him on solids. He's EBF, and I told her that I am planning to wait until 6 months if he continues to keep doing so well on breast milk alone. She was super supportive, but said to start him on iron drops, because he only has iron stores that cover him 4-6 months.

Everything I had read before said that healthy, term infants do not need iron supplements before 6 months because they have the iron stores, and the small amount of iron in breast milk is so well absorbed. But evidently the AAP recommends iron drops in EBF babies at 4 months. What have all of you done? Did you get the same advice as me?

 

[Kiwiberry]

I got the same advice for my baby. She is a preemie though who is still in the NICU and they give her vitamins and iron supplements. To be honest it can't really hurt so I say go for it.

 

[noon_child]

I got lots of conflicting advice about vitamins. I kept reading it was recommended from about 9?months here (UK) but my HVs kept saying I didn't need to give any because my LO was healthy and eating a full range of foods plus breastmilk by that age.

Anyway it ended up that my LO got a vitamin D deficiency because we live in the north of England. I wasn't making enough to transfer enough to her through BM and she wasn't making enough herself despite loads of time outside (just cos of where we live). She never was deficient in iron though.

I suppose you just have to check there are no side effects to having iron so young (I know it can constipate adults) and if not then you may as well.

 

[Kiwiberry]

Iron is important to support brain development and contributes to the.baby's griwth. BF babies usually begin iron supplements around 4 months. Iron has a bad rep but scientific evidence shows iron in your babies diet provides many benefits. The bad reputation of iron are just myths. There is no medical basis for it. Not enough iron cam lead to a variety of problems for your baby. Including slower physical growth, delayed motor skills, decreased social behavior, lower learning ability, muscle weakness, and digestive problems.

 

[MommyJogger]

We got the advice with my first to start supplementing at 6 months. We did and my mostly-breastfed (meaning breast milk and negligible solids) had a few horrendously hard poops (no idea how his body even managed that on a breast milk diet) and we stopped. My second is only two months, but our plan is to have his iron levels checked at 6 months and 1 year and only supplement for a true deficiency. If you had delayed cord clamping, I don't think there's actually much to worry about because these babies don't have as high a risk of iron deficiency. The studies showing "too low" iron at 6 months are based on populations when immediate cord clamping was the norm.
As a microbiologist and biochemist, I would also say it's debatable that iron supplementation has no risks. If a normal, breastfed baby has 'low' iron at 6 months, I think it's important to consider the possibility that what we describe as 'low' is actually quite normal. Not that having higher iron definitely damages anything-- the reasons for low iron might not even be applicable to modern life (we may have evolved to have low iron in order to prevent infections from ingested microorganisms when solids were started, but modern hygiene would mostly make that moot).
The reason we choose to opt out of iron supplementation in the absence of a demonstrated true iron deficiency is because we would like to preserve the normal stomach and intestinal flora. You can't just drop an iron bomb into a pool of bacteria and expect the balance between different microbes to be maintained.
And in some children, iron supplementation will actually decrease their ability to absorb iron. The iron in the supplements is a different form than the iron you get from animal-based food sources. Adding lots of difficult-to-absorb iron to a pool with low easy-to-absorb iron can, to put it simply, 'hide' the easily absorbed iron. In actual deficient individuals, the increase in total iron is more beneficial because the heme-iron is so low anyway. But in individuals who are getting decent dietary iron are more at risk of the supplements doing very mild harm than any good.
So because we were able to delay cord clamping, we're declining routine iron supplementation in the absence of a demonstrated need and his first foods will likely be shredded beef and chicken.

 

[luna_19]

My lo was ebf for 6 months them did blw so started out very slow on solids. Never had any iron suppliments or even blood tests. It is a myth that bf babies run out of iron so early, iron stores START to deplete around 6 months but it's not an instant thing, the vast majority of bf babies are eating enough solids by about a year to never have iron issues.

 

[Kiwiberry]

I think I would be more inclined to believe medical professionals than random people on the internet. To each their own though.

 

[hiladun]

Sadly I find again and again that the majority of HCPs - including midwives, HVs and in the US paediatricians especially - are beyond woefully undereducated in all things BF.

 

[Kiwiberry]

Sadly I find again and again that the majority of HCPs - including midwives, HVs and in the US paediatricians especially - are beyond woefully undereducated in all things BF.

I suppose you are the expert on the matter then?

I however, strongly disagree with you. Not everyone will know how to BF, but that does not mean they don't know how the human body works or what is produced in BM.

Furthermore, how can you have any comment on pediatricians when you live in the UK and to my knowledge have no experience of what its like here in the US. Also, may I add that our pediatricians attend school for twice the amount of time a MW does. Just throwing that out there.

 

[RaspberryK]

I never gave any kind of supplement at all, it was never recommended for us. It's my belief that if they were supposed to get it, it would naturally occur in breastmilk.
It's also my experience that unless the " professional" is a lactation consultant or breastfeeding supporter that they have absolutely no idea about breastfeeding.
Lots of advice from doctors etc to be feeding on a schedule/dropping feeds from 6 months.
Xx

 

[MommyJogger]

Pediatricians are trained to treat illness. If I trusted them so blindly with advice about regular care, I would retract my sons' foreskins at every diaper change, bathe them in salicylic acid to get rid of harmless cradle cap, and leave them in dirty diapers for hours to make them potty train faster.

 

[MommyJogger]

I was also told by one that the bottom of the chest buckle is supposed to line up with the armpit, so they're pretty bunk with car seat safety, too, which should be pretty relevant to their practice.

 

[hiladun]

Sadly I find again and again that the majority of HCPs - including midwives, HVs and in the US paediatricians especially - are beyond woefully undereducated in all things BF.

I suppose you are the expert on the matter then?

I however, strongly disagree with you. Not everyone will know how to BF, but that does not mean they don't know how the human body works or what is produced in BM.

Furthermore, how can you have any comment on pediatricians when you live in the UK and to my knowledge have no experience of what its like here in the US. Also, may I add that our pediatricians attend school for twice the amount of time a MW does. Just throwing that out there.

How incredibly and unnecessarily antagonistic.

Not to mention hypocritical: you don't need to have BFd to know about BF (paraphrasing you) but I DO need to be in the US and have personally seen a paediatrician if I am to be allowed to express an opinion about them? Ridiculous.

Incidentally where do you get your stat from that EBF babies 'usually' start iron at 6mo?

You only need to look at this BF board to see the shocking precedence of "my ped/HV/midwife/GP told me to top up with formula as because LO wasn't sttn at 6 weeks/was a heavy baby/was cluster feeding/had a growth spurt/had TT/had thrush/was 6mo/was 1yr old/showed any other normal BF behaviour/I needed meds/Etc etc" - plenty of HCPs are simply clueless about BF despite whether they are technically 'trained' (GPs I think have a few hours devoted to the subject during their years for instance in BF.

Op, in answer to your question, I agree with the pps that have said it's not necessary for a medically normal 6mo who's mainly BF and starting solid. As such I for one would not be giving an iron supplement in the absence of evidence, ie results of a blood test, that my LO had an iron deficiency. I should think if there was good reason to suspect low iron then such a test would be a given,
indeed I would expect the dr to suggest it.

 

[Kiwiberry]

I guess because you read these boards you are suddenly "in the know" about all things BF'ing. I am not saying there are not people out there who don't make mistakes, but what I am saying is that you are applying a blanket statement that quite frankly is just not true.

Yes you need to be in the US to experience a pediatrician in the US. You specifically said the US, so you were the one who was being antagonistic. You can't take other peoples experiences and apply them to yourself as if you were the one experiencing it. That is just perpetuating a stereotype and jumping on a bandwagon blindly.

Pediatricians may not be trained in BF'ing, but if they see your baby is low on iron they will give you wasy to help get that up. That is what they are trained to do, they don't have to be an expert in BF to know that or to diagnose that.

Why is this thread even a question? If there is something you should do to help your baby be healthy then why not do it? It is not like giving extra iron to your baby is going to cause a problem it is harmless and can only help your baby in more ways than not.

As is the nature of the internet you will only ever see people complaining because they have an issue. If someone is happy in any situation then you normally do not see them going out of their way to let everyone know that. This can be applied to almost every situation including pediatricians. You may see a couple hundred people complaining about how their Pedi did this and their pedi did that, but what you don't see is the millions of people who are happy with the way their baby is being looked after. Sadly though like yourself, not many people actually realize this and instantly assume what they read on forums or various other community's must be the truth. That is just plain ignorance.

 

[luna_19]

Supplementing non water soluble minerals/vitamins such as iron can actually be very dangerous if they are not needed. There is nothing wrong with questioning advice especially when it is different than other doctors often give. I think the bottom line here is if your doctor tells you to give an iron suppliment requesting a blood test to confirm that it is actually needed is a really good idea.

 

[Kiwiberry]

Well obviously if you have too much of something then of course its bad. What I was talking about was babies who are actually low on iron.... Why else would a medical professional tell you to take vitamins if they did not believe the baby was low on said vitamin?

 

[MommyJogger]

I guess because you read these boards you are suddenly "in the know" about all things BF'ing. I am not saying there are not people out there who don't make mistakes, but what I am saying is that you are applying a blanket statement that quite frankly is just not true.

Yes you need to be in the US to experience a pediatrician in the US. You specifically said the US, so you were the one who was being antagonistic. You can't take other peoples experiences and apply them to yourself as if you were the one experiencing it. That is just perpetuating a stereotype and jumping on a bandwagon blindly.

Pediatricians may not be trained in BF'ing, but if they see your baby is low on iron they will give you wasy to help get that up. That is what they are trained to do, they don't have to be an expert in BF to know that or to diagnose that.

Why is this thread even a question? If there is something you should do to help your baby be healthy then why not do it? It is not like giving extra iron to your baby is going to cause a problem it is harmless and can only help your baby in more ways than not.

As is the nature of the internet you will only ever see people complaining because they have an issue. If someone is happy in any situation then you normally do not see them going out of their way to let everyone know that. This can be applied to almost every situation including pediatricians. You may see a couple hundred people complaining about how their Pedi did this and their pedi did that, but what you don't see is the millions of people who are happy with the way their baby is being looked after. Sadly though like yourself, not many people actually realize this and instantly assume what they read on forums or various other community's must be the truth. That is just plain ignorance.

First bolded: this is not a thread about supplementing a child low in iron. It's a thread about the validity of routine iron supplementation, which is ironically the same kind of blanket advice you seem offended by.

Second bolded is outright false. It will help a specific subset of babies, not affect another subset, and hurt another subset. With the importance of the nuances of the human microbiome just coming to the attention of medical research recently (recent for this kind of research at least), there's no way of knowing what proportion is in each group, but almost any intervention applied routinely without knowing the outcome of the intervention in healthy groups is crazy.

 

[MommyJogger]

Well obviously if you have too much of something then of course its bad. What I was talking about was babies who are actually low on iron.... Why else would a medical professional tell you to take vitamins if they did not believe the baby was low on said vitamin?

The AAP recommends routine supplementation, without bothering to check if the baby is low. They say that being breastfed is good enough reason to assume it's low, because bf infants tend to have lower iron than ff ones. It comes frim a ff culture where pediatricians use ff infants as the norm and measure bf babues against them, rather than taking a bf infant as normal and saying ff infants are too high in iron. They don't actually know empirically what an optimal range is.

 

[Kiwiberry]

One of the reason they say that BF babies are low on iron compared to FF babies is because BF babies have a higher rate of anemia which is caused by iron deficiency. If the iron stores were enough, then BF babies would not have a higher occurrence of anemia. I agree that babies should be checked properly with a blood test, but that is honestly up to the parents to request if in any case the medical staff do not. It is not that hard to request a blood test.

 

[MommyJogger]

I'll leave this here.
https://kellymom.com/nutrition/vitamins/iron/